对冲性重型颅脑损伤双侧去骨瓣减压疗效分析

目的:探讨双侧去骨瓣减压开颅术治疗双侧对冲性重型颅脑损伤(DHSCI)的治疗效果.方法:将52例DHSCI患者随机分为治疗组和对照组,每组26例.治疗组给予双侧去骨瓣减压开颅术治疗,对照组给予标准单侧外伤大骨瓣减压窗手术治疗.观察两组急性脑膨出和切口疝发生情况,记录术后1,3,5d颅内压情况,术后随访3个月评价临床疗效.结果:治疗组急性脑膨出和切口疝发生率分别为15.4％(4/26)和26.9％(7/26),均显著低于对照组的57.7％(15/26)和61.5％(16/26),两组比较差异有统计学意义(P＜0.01)；治疗组术后1,3,5d颅内压(21.54±3.15),(17.43±2.93),(15.92±2.91) mmHg均分别显著低于对照组(30.20±4.16),(29.73±4.06),(24.10±3.01) mmHg](均为P＜0.05)；治疗组临床治疗有效率为50.0％(13/26),显著高于对照组的23.1％(6/26)(P＜0.05)；治疗组病死率为19.2％(5/26),显著低于对照组的42.3％(11/26)(P＜0.05).结论:双侧去骨瓣减压开颅术治疗DHSCI疗效明显优于标准单侧外伤骨瓣减压窗手术,可以减少急性脑膨出和切口疝的发生,患者预后良好.

Application of Bilateral Decompressive Craniotomy in the Treatment of Double Hedge Severe Craniocerebral Injury

Objective: To investigate the clinical efficacy of bilateral decompressive craniotomy in the treatment of double hedge severe craniocerebral injury(DHSCI).Methods: Fifty two patients with DHSCI were divided by random digits table method into treatment group and control group with 26 cases in each group.The treatment group were treated with bilateral decompressive craniotomy,while the control group were treated with traditional unilateral craniotomy.The acute brain swelling,incisional hernia,and intracranial pressure on the 1st,3rd,and 5th days post-operation were observed and recorded.The patients were followed up for 90 days to evaluate the clinical efficacy.Results: The incidence of acute brain swelling and incisional hernia in treatment group were 15.4%(4/26) and 26.9%(7/26),respectively,which were significantly lower than 57.7%(15/26) and 61.5%(16/26) respectively in control group(both P<0.01).The intracranial pressure on the 1st,3rd,and 5th days in treatment group was(21.54±3.15),(17.43±2.93),and(15.92±2.91) mmHg respectively,which were significantly lower than that of control group(30.20±4.16],29.73±4.06],and 24.10±3.01] mmHg respectively)(all P<0.05).The clinical efficacy of treatment group was significantly higher than that of control group as 50.0%(13/26) versus 23.1%(6/26)(P<0.05).The mortality rate of treatment group was 19.2%(5/26),which was significantly lower than 42.3%(11/26) in control group(P<0.05).Conclusion: Compared with traditional unilateral craniotomy,bilateral decompressive craniotomy can reduce the incidence of acute brain swelling and incisional hernia of DHSCI patients,and shows better prognosis.It is worthy of clinical application.